Key result
Prior oral anticoagulation is linked to similar stroke recurrence versus naïve patients in AF.
Why the study?
Despite widespread oral anticoagulant use, the real-world effectiveness of OACs and the influence of anticoagulation type and quality on preventing recurrent strokes following an initial cardioembolic stroke remain major clinical challenges.
Does oral anticoagulant use at admission reduce stroke recurrence in atrial fibrillation patients admitted with cardioembolic stroke?
Observational (n=128)
Does oral anticoagulant use at admission reduce stroke recurrence in atrial fibrillation patients admitted with cardioembolic stroke?
Answers are grounded in this paper and cite their sources.
In atrial fibrillation patients with cardioembolic stroke, prior oral anticoagulant use alone did not significantly reduce stroke recurrence compared to being anticoagulation-naïve, emphasizing that optimal treatment quality is critical.
Background/Objectives: Despite the widespread use of oral anticoagulants (OACs), acute ischemic stroke (AIS) remains a significant risk for patients with atrial fibrillation (AF). The real-world effectiveness of OACs in preventing recurrent strokes, particularly following an initial stroke of cardioembolic (CE) origin, continues to be a major challenge for clinicians managing AF patients. This study evaluated the efficacy of OACs in secondary stroke prevention and investigated the influence of anticoagulation type and quality on recurrence risk. Methods: We analyzed data from 128 AF patients in the prospective Transzlációs Idegtudományi Nemzeti Laboratórium (TINL) STROKE-registry, admitted with CE stroke between February 2023 and September 2024. Patients were categorized by anticoagulation status at admission (OAC-users, n = 89; anticoagulation-naïve, n = 39). Recurrence rates were assessed using logistic regression models, adjusted for age, sex, hypertension, diabetes, and pre-stroke disability. Subgroup analyses explored the effects of anticoagulation type and quality. Results: Recurrence rates were similar between the OAC-treated and anticoagulation-naïve patients after adjusting for confounders (19.10% vs. 17.95%, p = 0.870). Among the anticoagulated patients, neither anticoagulation type nor quality alone significantly influenced the recurrence risk. However, their interaction was statistically significant (p = 0.049), suggesting that the effectiveness of anticoagulation in preventing strokes is strongly affected by treatment quality. Conclusions: Although OACs are a cornerstone of stroke prevention in patients with AF, their efficacy in reducing recurrence depends on optimal management. These findings highlight that adequate anticoagulation, not just its use, is critical to minimize recurrence risk. To effectively prevent strokes in high-risk AF patients, future strategies must focus on standardized protocols, tailored monitoring, and individualized dosing regimens.
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Seetge et al. (2024) conducted an observational in Atrial fibrillation with cardioembolic stroke (n=128). Oral anticoagulants (OACs) vs. Anticoagulation-naïve was evaluated on Stroke recurrence rate (p=0.870). Oral anticoagulant use prior to admission was associated with similar stroke recurrence rates compared to anticoagulation-naïve patients (19.10% vs. 17.95%, p=0.870) in AF patients with CE stroke.
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